Inspection on 10/11/05 for Millfield Nursing And Residential Home

This inspection was carried out on 10th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Millfield Nursing And... 30/05/08

Millfield Nursing And... 13/09/07

Millfield Nursing And... 09/10/06

Millfield Nursing And... 04/05/05

Millfield Nursing And... 07/01/05

Millfield Nursing And... 17/08/04

Millfield Nursing And... 12/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Millfield Nursing And Residential Home Cedar Park Drive Bolsover Chesterfield Derbyshire S44 6XP Lead Inspector Bridgette Hill Unannounced Inspection 10th November 2005 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000002065.V265265.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000002065.V265265.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Millfield Nursing And Residential Home Address Cedar Park Drive Bolsover Chesterfield Derbyshire S44 6XP 01246 825959 01246 825923 millfield@highfield-care.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Care Management Limited Donna Smith Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places DS0000002065.V265265.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th May 2005 Brief Description of the Service: Millfield is a purpose built care home set within a modern housing estate, on the outskirts of Bolsover. The home is registered to admit up to 40 elderly people with nursing and/or personal care needs. Millfield provides a pleasant environment for the service users and the accommodation is provided on two floors. There is passenger lift and staircase access to the first floor facilities. There are lounge/dining areas on both floors of the home. All bedrooms are single occupancy, with en-suite facilities. The staff call/alert system operates in all areas of the home. There is an outdoor courtyard area in the centre of the home, accessible to the service users. The home has a hairdressing salon. Support services are in place with a choice of General Practitioners, and chiropody, dental, optician and other services arranged as appropriate. DS0000002065.V265265.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced one which took place over 5 hours. As part of the inspection two staff members were spoken with. A sample range of records were examined including care files. As the manager was not on duty on 10th November 2005 a brief follow up visit was undertaken on 14th November 2005 to meet with the manager. Two relatives and one service user were spoken to regarding their experiences at Millfield Care Home. This report should be read alongside the one for the inspection undertaken on 4th May 2005 where many core standards were assessed as being met. What the service does well: What has improved since the last inspection? What they could do better: The supervision of staff requires developing and regular implementation to ensure that it meets standards. There remain a number of unmet requirements in relation to medicines, care plans and the environment that despite quality assurance systems being implemented these have not been addressed. Some changes have taken place to paperwork since the new provider has taken over. There appears to be slow progress being made to ensure that information is available to service users and some paperwork has introduced has not improved for example the signing space for service users on new care plans has disappeared to be replaced by the signing of an index which does not validate or allow an audit of which care plans have been agreed by service users. DS0000002065.V265265.R01.S.doc Version 5.0 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000002065.V265265.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000002065.V265265.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 The procedure to ensure that service users are appropriately assessed are being implemented however the information given to service users is out of date and has been for many months. EVIDENCE: The Statement of purpose and Service User Guide had not been updated to reflect changes in the company. Staff spoken to said that this was under review but was not yet made available to service users. This is an outstanding requirement from previous inspections. The inspection report was made freely available to service user and visitors in the entrance hall. The file of a newly admitted service user was examined. This confirmed that the Manager had undertaken a pre admission assessment and had obtained a nursing assessment of the service user. The family of the service user had visited the home prior to admission and a plan of care was written on admission. DS0000002065.V265265.R01.S.doc Version 5.0 Page 9 This home does not provide intermediate care as defined by National Minimum Standards. DS0000002065.V265265.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,11 Whilst care plans were in place for each there was not specific information recorded to ascertain how care was to be delivered to meet assessed needs. EVIDENCE: A sample of two service users care files were examined. These contained basic information regarding the service user and a photograph. Some care plans were in the process of being transferred over onto the new companies paperwork. The new form for recording the plan of care did not have space for the service user to sign. The space for the service user to sign was on an index. This allowed for the possibility of the care plan being signed for to be altered without the consent/knowledge of the service user. It is recommended that this be reviewed. The content of care plans again was general in describing how care needs were to be met using phrases such as ‘provide pads as assessed’ for a continence need. Therefore the plan of care was vague and not descriptive of how an individuals assessed care needs were to be met. One daily record completed DS0000002065.V265265.R01.S.doc Version 5.0 Page 11 described a service user as being a ‘nuisance’ this is an inappropriate and subjective approach to recording. Care plans reviews and 6 monthly reviews to which relatives were invited were documented. Relatives spoken to said they found the care given at the home to be good and particularly the liked the good standards of personal hygiene for service users. Previous requirements relating to the storage and administration of medicines were examined. There were a number of gaps evident on medication administration records without a code recorded. This included a course of antibiotics where codes were missing. The majority of medication administration records were printed however not all hand written entries were verified and doubly signed. There had been changes made to the process of disposing of drugs. The Manager said that the procedure for this had not been updated accordingly. One care file contained post death wishes the second examined did not. The format of the records included a section regarding resuscitation. A decision not to resuscitate was signed in one care file by a relative. It is of note that legally this relative was not the closest relative available. The service user was according to staff able to understand and sign meaningfully signed most of the care plans in this file but not this section. It is of concern that a decision not to resuscitate was recorded for one service user without documentary evidence of any medical input into the decision and that a relative who was not legally next of kin had signed this when the service user had full capacity to make decisions for themselves. Staff spoken to could not locate any policy guidance on the completion of this section and further clarification to staff must be available in order that there is full multi disciplinary consideration given to such serious decisions. DS0000002065.V265265.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 (previous requirement only checked) Whilst it was evident that a range of activities were being offered care files did not record the service users preferences or assessed social needs in a personalised way. EVIDENCE: One care examined did not contain a plan of care detailing assessed social needs or how these were to be met. This is an outstanding requirement from previous inspections. One care file did contain a social care plan but this was not detailed in specific preferences of the service user. It was evident that a range of craft activities had taken place and a number of paintings were on sale to raise proceeds for the home. One service user spoken to said there were various activities held at the home including exercise classes, art, and there were opportunities to go out from the home. It was also said that staff were kind in their approach to assisting those who needed help to eat. Service users spoken to said the food was good and it was evident that service users were given a choice of meal. DS0000002065.V265265.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Where complaints had been made these were found to have been investigated fully however some information required updating to ensure that complainants had accurate information on how to complain to the Provider. EVIDENCE: There had been 3 complaints recorded since the last inspection was undertaken. Records were available of these and records of investigations were available. The complaints procedure was on display in the entrance hall. Some addresses given for complainants to contact were not accurate within the Service User Guide available in the entrance hall as the address had changed when the company changed. The address of Commission for Social Care Inspection was included in the Service User Guide available. Relatives spoken to said that felt they would be able to approach staff at the home if they were concerned about anything. One service user said they had expressed a concern about something and felt improvements had been made in response to this. DS0000002065.V265265.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 Previous requirements only checked Only the unsuitable locks have been removed since the last inspection and there has not been any compliance achieved to meet a number of outstanding requirements from the previous visit. EVIDENCE: At this visit only previous requirements and recommendations were assessed with regards to the environment. The unsuitable chain style locks have been removed from bedroom doors. The corridors and kitchen continue to require redecorating.. This is outstanding from the last inspection. It is a requirement from the Environmental Health Officers that the kitchen needs redecorating. The Manager said that quotes were being obtained to have this work completed. No work had been completed to improve the smoke extraction system in the upstairs smoke lounge and staff spoken said this smelt heavily of smoke. No DS0000002065.V265265.R01.S.doc Version 5.0 Page 15 improvements had been made to the lighting in the corridors which is recorded as a recommendation. Three additional variable height beds have been delivered since the last inspection. DS0000002065.V265265.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,31 Suitable recruitment procedures were in place and being implemented to ensure that as far as was possible suitable staff were being employed. EVIDENCE: A sample of three staff personnel files were examined. These were organised and contained Criminal Records Bureau checks, references, proof of identity and photographs. Each employee had a job description and contract of employment. Each employee began work on a 3-month trial basis prior to being confirmed in a permanent post. DS0000002065.V265265.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36,37 Quality assurance and managerial systems appeared to be in place however some work continues to be required to ensure that standards are met for supervisions and record storage/keeping. EVIDENCE: The Manager of the home has successfully completed a managerial qualification in July 2005 and appeared to be organised. Relatives spoken to said the Manager was approachable. The process of implementing staff supervision had begun. A form had been devised to record this however this gave extremely little space (no more than 3-4 words) to record discussions and planning. There was space for staff and the supervisor to sign the forms. No specific dates were recorded on the forms and the last supervisions took place in May/June 2005. For some staff there were no recorded supervisions at all. Discussions with the Manager confirmed DS0000002065.V265265.R01.S.doc Version 5.0 Page 18 that a new document for recording supervisions was to be introduced which was more comprehensive. All the forms available were for care staff and discussions held with nursing staff confirmed that there was no supervision structure in place for qualified nurses. The Manager completed quality assurance audits on a monthly basis and records of monthly visits made by the Operations Manager on behalf of the provider had been completed on a regular basis. The quality assurance document was a detailed one which covered all aspects of the running of the home. Despite this there remains a number of unmet requirements listed. As at the previous inspection the office was found to unlocked with the propped open and was frequently unsupervised throughout the inspection with care files and personal data stored on open shelves. This is an outstanding requirement from previous inspections Accident records were examined. These were found to be recorded in a book format with double sided pages containing information for more than one service user. This is against the data protection guidance. An instruction in the accident book directed staff to file a copy of the record in the service users care file but this was not being completed. DS0000002065.V265265.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x 2 2 x x x x x x STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 x 2 2 x DS0000002065.V265265.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Schedule 1 4(1)c Requirement The statement of purpose must be updated to reflect changes in the companies organisation Previous timescale 30/07/05 Care plans must be individualised and descriptive of how assessed needs are to met Previous timescale 30/07/05 If it is assessed as inappropriate that the service user or their representative are consulted regarding their plan of care or this option is declined this must be recorded. Previous timescale 30/07/05 Residents must be consulted regarding their personal hygiene preferences Previous timescale 30/07/05 If a Medication Administration Record (MAR) chart is handwritten by a member of staff this must be signed and dated by them. This must then be checked, signed and dated by DS0000002065.V265265.R01.S.doc Timescale for action 31/12/05 2 OP7 15(1) 31/01/06 3 OP7 15(1)(c) 31/01/06 4 OP7 12(2)(3) 31/01/06 5 OP9 13(2) Schedule 3 30/11/05 Version 5.0 Page 21 a second member of staff. 6 OP9 13(2) Schedule 3 Previous timescale 30/07/05 All Medication Administration 30/11/05 Records (MAR) must have codes recorded where medicines are due to be given recording if it was given or a reason that it was not given Previous timescale 30/07/05 The disposal of medicines procedure must reflect the practices in place at the home Residents must be consulted regarding their post death wishes This must be reviewed regularly. Where this is considered inappropriate the reasons for this must be recorded Clear guidance with consideration being given to medical, legal and ethical issues must be available to staff prior to completing service users resuscitation wishes Care plans must include details on how social care needs are being met according to assessed needs Previous timescale 30/08/05 The providers address must be accurately recorded on all complaints procedures The findings of the latest Environmental Health report must be acted upon Dates given previously 31/3/05 30/07/05 An action plan must be produced identifying early timescales for the redecoration of corridors and staircase/stairwell areas (downstairs only completed at visit on 4th May 2005) DS0000002065.V265265.R01.S.doc 7 8 OP9 OP11 13(2) Schedule 3 12 31/12/05 28/02/06 9 OP11 12 31/12/05 10 OP12 15(1) 16(2)(m) 31/01/06 11 12 OP16 OP19 22 23(5) 31/12/05 28/02/06 .13 OP19 23(2)(d) 28/02/06 Version 5.0 Page 22 14 OP19 23(2)(b) Dates given previously 31/3/05 30/07/05 The Provider must ensure there 28/02/06 are systems and resources in place to ensure the home is maintained to required standards Previous timescale 30/08/05 Communal space in the home must be appropriately furnished so that is suitable for the social, cultural and recreational needs of the residents 28/02/06 15 OP20 23(2)(g) 16 OP36 18(2) Previous timescale 30/08/05 All staff must receive appropriate 31/01/06 training and supervision Training had been addressed, but the frequency of supervision did not meet requirements 17 OP37 17(1)(b) Previous timescale 30/07/05 Service user care records must be held securely to ensure confidentiality is maintained Previous timescale 30/07/05 Service user records must be individually kept in accordance with data protection guidance 31/12/05 18 OP37 17(1)(b) 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Each care plan should have a space for the service user to sign as opposed to an index whereby the care plan can be changed without the knowledge/participation of the service user DS0000002065.V265265.R01.S.doc Version 5.0 Page 23 2 3 OP7 OP14 Staff must receive training to ensure care records are not descriptive as opposed to being subjective in recorded findings Information about rights of access to records should be included in the Service User Guide Not able to assess at this visit as new Service User Guide was not available The Provider should implement an effective smoke extraction system for the smoking lounge The quality of the lighting should be improved in corridor areas (deterioration of the current light fittings) 4 5 OP20 OP25 DS0000002065.V265265.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000002065.V265265.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!